Curriculum Quiz: Cardiology

Question 1 of 30

1. Question

A patient presents with a broad complex tachycardia. Which one of the following is not an indication for immediate cardioversion?

Rate > 150 bpm
Systolic BP < 90
Severe chest pain
New-onset elevated JVP and sacral oedema
Bibasal lung crepitations

Question 2 of 30

2. Question

Which one of the following statements about cardiac markers is the most appropriate?

Troponin levels remain elevated for approximately two weeks following AMI
Troponin levels are highly sensitive and specific for myocardial ischaemia
Troponin levels rise and fall faster than CK-MB
Urgent troponin assay is indicated in patients with ischaemic chest pain and ST segment elevation on their ECG
CK-MB no longer has a role as a cardiac marker

Question 3 of 30

3. Question

Which one of the following would be an unusual ECG finding early after a heart transplant?

Sinus tachycardia
Sinus bradycardia
Sinus rhythm with atrial premature beats
Atrioventricular (AV) block
Right bundle branch block (RBBB)

Question 4 of 30

4. Question

A 65-year-old man presents with an episode of chest pain which has lasted approximately 2 hours. He describes it as retrosternal and burning in nature. It radiated to his left arm. He is a smoker and has hypertension but is otherwise well.

Which one of the following would not increase his likelihood of having an acute myocardial infarction?

A third heart sound
Tachycardia
Pulmonary crepitations
Hypotension
Diaphoresis

Question 5 of 30

5. Question

Examine the ECG below. What is the ECG diagnosis?

Sinus tachycardia
Re-entrant SVT
Atrial Fibrillation
Atrial flutter with 2:1 block
Multifocal atrial tachycardia

Question 6 of 30

6. Question

A 65-year-old man presents with sudden thoracic pain and is suspected of having an acute aortic dissection.

Which of the following is the most common predisposing factor for this disease?

Atherosclerosis
Hypertension
Marfan syndrome
Bicuspid aortic valve
Turner syndrome

Question 7 of 30

7. Question

Regarding endocarditis, which one of the following statements is correct?

Loeffler’s (eosinophilic) endocarditis responds well to hydroxyurea treatment
NBTE (Non Bacterial Thrombotic Endocarditis) is related to Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD)
Antibiotic treatment reduces embolic phenomenon in infective endocarditis by half after three weeks of treatment
Trans oesophageal echocardiography has a false negative rate of less than 5%
Even with appropriate treatment, 5 year mortality for Injected drug users with right sided endocarditis is the highest

Question 8 of 30

8. Question

A 36-year-old man presents to the emergency department with acute chest pain. Which of the following features of his clinical history would most strongly suggest that he has an acute coronary syndrome?

His pain is not associated with exertion
He describes the pain as an indigestion-like burning
He has a history of hypertension
He reports that his father had a heart attack at the age of 52
He describes the pain as a feeling of tightness

Question 9 of 30

9. Question

A 55-year-old lady attends the ED having collapsed with a GCS of 6/15. You suspect she has a subarachnoid haemorrhage (SAH). Her ECG shows ST segment elevation.

Which one of these statements is True?

25% of patients with SAH have ST segment elevation on their ECG
ST segment elevation is the commonest ECG abnormality associated with SAH
T wave inversion is the commonest ECG abnormality associated with SAH
ST depression is the commonest ECG abnormality associated with SAH
The presence of ST elevation excludes the diagnosis of SAH

Question 10 of 30

10. Question

A 72-year-old man presents with ischaemic chest pain of three hours’ duration. He has a past history of hypertension and hypercholesterolaemia. On examination he is haemodynamically stable and his chest pain is resolving with opiate analgesia, GTN, and aspirin. His standard 12 lead ECG shows ST segment depression in the anterior chest leads. Troponin assay is awaited.

With the information given, which of the following statements is most appropriate?

The diagnosis is anteroseptal ischaemia (UA)
The diagnosis is Non-ST segment elevation myocardial infarction (Non-STEMI)
Diagnosis is posterior ST segment elevation myocardial infarction (STEMI)
The diagnosis is Non-ST segment elevation acute coronary syndrome (Non-STEACS)
The diagnosis is none of the above

Question 11 of 30

11. Question

A 68-year-old woman attends the emergency department (ED) complaining of thoracic pain.

Which of the following is the most common presenting symptom of acute aortic dissection?

Tearing interscapular pain
Gradual chest tightness
Sudden abdominal pain
Sudden anterior chest pain
Sudden chest pain that radiates to the arm

Question 12 of 30

12. Question

With respect to acute myocarditis, which one of the following statements is correct?

The 5 year mortality from all forms of the condition is 10-15%
The condition may present as sudden death in a previously healthy adult
Greater than 90% of patients have normal cardiac function 1 year after presentation
It cannot be diagnosed at post mortem
It can be definitively diagnosed in the emergency department

Question 13 of 30

13. Question

A 54-year-old man presents with sudden onset retrosternal chest pain radiating through to the back. He has a history of hypertension for which he takes atenolol but is otherwise well. On examination, he is in pain, has a pulse of 105 and a blood pressure of 185/105. He has an early diastolic murmur and his chest is clear. His ECG reveals ST segment elevation in the inferior leads and his CXR reveals a widened mediastinum.

Which of the following statements is most appropriate?

Intravenous nitrate can be used to control his blood pressure
Intravenous opiates are not an immediate priority
He should be considered for urgent pharmacological reperfusion in view of his ST elevation
This presentation constitutes a hypertensive urgency
Further investigation is required before definitive treatment can be instituted

Question 14 of 30

14. Question

Which one of the following characterises paroxysmal atrial fibrillation (AF)?

Restoration to sinus rhythm with treatment
Self-limiting episodes of AF
Infrequent episodes of AF
Brief episodes of AF

Question 15 of 30

15. Question

An eight month pregnant Asian 27-year-old woman presents with breathlessness and palpitations.

Which of the following heart valve disorders is most likely to be the cause of her symptoms?

Mitral stenosis
Mitral valve prolapse
Aortic stenosis
Mitral valve regurgitation
Aortic valve regurgitation

Question 16 of 30

16. Question

Which of the following statements, concerning management of low risk chest pain, is correct?

Inadvertent discharge with myocardial infarction must be avoided at all costs
There is no role for troponin testing
Patients routinely require cardiology review
Repeated ECG recording is mandatory
Unnecessary hospital admission should be avoided if possible

Question 17 of 30

17. Question

If a patient with a device set to a lower rate limit (LRL) of 50 bpm is in normal (unpaced) sinus rhythm at 47 bpm, which one of the following is the most likely explanation?

Hysteresis has been programmed on
The device is an ICD
The device has failed
The ventricular pacing threshold has risen
The ventricular lead has displaced

Question 18 of 30

18. Question

A 45-year-old woman presents with dizziness, chest pain and palpitations. She is previously well. She has a tachycardia of 200.

You are unsure if she has a supraventricular or ventricular tachycardia (VT). Which one of the following is most indicative that the tachycardia may be supraventricular?

A loud first heart sound
Lack of previous cardiac problems
Cannon waves in the jugular venous pressure (JVP)
Hypotension
Normal consciousness

Question 19 of 30

19. Question

Which one of the following is the commonest cause of acute pericarditis?

Bacterial infection
Trauma
Systemic autoimmune disorders
Secondary metastatic tumours
Viral infection

Question 20 of 30

20. Question

Which one of the following is the most common presenting symptom of pulmonary hypertension?

Dyspnoea
Peripheral oedema
Syncope
Angina
Fatigue

Question 21 of 30

21. Question

A 50-year-old heavy smoker is brought in complaining of severe increased shortness of breath and a non-productive cough. Pulse 112, BP 105/62, RR 24, SaO2 89% on room air, temperature 36.9o. Looking at the chest x-ray, which one of the following statements is true?

Click on the x-ray to enlarge.

The film shows a mass at the right hilum
There is hyperinflation and diaphragmatic flattening
The artefact on the right side is an ECG monitoring lead
There is a right sided pneumothorax
There is clear evidence of an infective cause for the symptoms

Question 22 of 30

22. Question

A 67-year-old lady presents with collapse and marked respiratory distress; she is pale, tachypnoeic, tachycardic and has a reduced conscious level. She is known to have ischaemic heart disease and has presented previously with acute pulmonary oedema.

Which one of the following investigations will be most helpful in confirming this diagnosis?

ECG
ABG analysis
Troponin
Pulse oximetry
CXR

Question 23 of 30

23. Question

Which of the following is the most common cause of a regular broad complex tachycardia (BCT)?

Atrial flutter with bundle branch block
Fascicular tachycardia
Supraventricular tachycardia (SVT) with bundle branch block
Ventricular tachycardias
Atrial fibrillation with bundle branch block

Question 24 of 30

24. Question

Which of the following regarding Brugada syndrome is true? (Select all that apply)

Genetically transmitted disease
Associated with potassium channel derangements
Typical presentation includes dizziness and headaches
More commonly seen among men
Easily diagnosed with an ECG

Question 25 of 30

25. Question

A 64-year-old suffered an out-of-hospital cardiac arrest post-MI. Following defibrillation, they now have a pulse but their non-invasive blood pressure is 60/30mmHg.

Which of the following options is your first management step?

Site a naso- or oro-gastric tube to relieve gastric distension
Give a 250ml fluid challenge and then immediately recheck the blood pressure
Site an arterial line for closer monitoring of their blood pressure
Provide inotropic support urgently

Question 26 of 30

26. Question

Which of the following statements regarding patients in cardiac arrest is false?

A 2 mg IV bolus of glucagon may benefit those in PEA routinely prescribed a beta blocker or calcium channel blocker
Elevation of the patient's legs by 20° is likely to improve venous return and thereby coronary and cerebral perfusion
The ALS manual recommends following each IV drug with at least 20 ml saline and arm elevation
The intraosseous route is preferred to the tracheal route for drug delivery if peripheral venous cannulation has failed
Ventilation at 15 bpm allows correction of the patient's mixed acidosis and is recommended once the patient's airway is secured

Question 27 of 30

27. Question

A 72-year-old patient presents with difficulty in breathing. He has a background of lung cancer with liver metastases. He is lethargic and finds it very difficult to speak. He has a long-term chest drain in place on the left. His initial observations are respiratory rate of 32, heart rate of 125, blood pressure of 75/40 and temperature of 36.8o C. His chest x-ray shows cardiomegaly and a small pleural effusion on the left side. His POCUS shows:

Image courtesy of Francisco Norman thepocusatlas.com

How would you manage this patient?

Urgent discussion with Cardiology for pericardiocentesis
Intravenous fluid boluses and reassess
CTPA for massive PE
Intravenous antibiotics and referral to critical care with severe sepsis

Question 28 of 30

28. Question

In patients with a left-to-right shunt, which of the following is a correct statement?

Patients with truncus arteriosus are usually breathless but not very cyanosed
Ventricular septal defect causes heart failure in the first 24 hours of life
A 10-year-old with very large ventricular septal defect might present to the emergency room with failure to thrive, basal crepitations and breathlessness
A persistent arterial duct is the commonest CHD in babies with Down syndrome
Peripheral oedema is a classic sign of right heart failure in infancy

Question 29 of 30

29. Question

A 74-year-old lady with known ischaemic heart disease and cardiac failure presents to the ED with a history of syncope. Which one of the following is true of syncope in the presence of cardiac failure?

The majority of cases of syncope in patients with a history of cardiac failure are benign
Drugs used in the treatment of cardiac failure may cause syncope
The absence of third and fourth heart sounds makes cardiac failure unlikely
The absence of an elevated jugular venous pressure makes biventricular cardiac failure unlikely
Cardiac failure rarely causes syncope in the absence of arrythmia

Question 30 of 30

30. Question

The LVAD is restarted and the patient is conscious. His ECG shows Ventricular tachycardia. What is your main priority now?

Sedation and Cardioversion
Give him a fluid challenge
Transfer to local VAD centre
Continue A-E assessment
Do nothing, this rhythm will settle on its own